The Lumps & Bumps Guide to Your Breasts

Finding a lump in your breast is, no doubt about it, scary. Cold sweat scary. Call your mom scary. M. Night Shyamalan scary. It is also perfectly normal. "Research has shown that at least half of all women experience some kind of noncancerous breast lump, bump or other symptom that strikes them as abnormal before they reach menopause," says Freya Schnabel, M.D., chief of breast surgery at Columbia University Medical Center in New York City. The operative word there is noncancerous—the vast majority of breast lumps pose no risk. Still, that probably won't be at the top of your mind if you find one. Jill Herzig was 34 and pregnant when she felt a lump. "I was trying to fit my newly big breasts into my not-yet maternity bra, and I felt this lump that felt like an olive," she says. "I was shaken, and immediately went to my ob-gyn. She sent me for a biopsy to be sure, but said, I've felt a lot of cancer in my life, and this isn't cancer.' She was right—it was something called a lactating adenoma caused by my pregnancy."

Sarah G. was 22 when she felt her first lump while in the shower. It was about the size of a peanut, but not as hard, and it terrified her right into her doctor's office. "My ob-gyn reassured me that the lump was a normal part of fibrocystic breast changes, which she told me are common, and she nixed further tests," she says. "Every once in a while my breasts still feel lumpier or more tender, but now I don't think twice about it. Those symptoms are simply a part of having fibrocystic breasts—or just having breasts at all!"

How can you know which of your breasts' inevitable quirks are worth worrying about and which aren't? First arm yourself with the reassuring info that often gets brushed aside in favor of dire warnings in the media. Then read up on the latest research on how to keep your risk minuscule. It's all here, and it's all meant to put you at ease.

When to worry, when to relax

Though all lumps deserve your attention, any lump a young woman finds is very unlikely to be a cancer—breast cancer affects only about one one hundredth of one percent of women under 40. And even in breast lumps that require a biopsy, some 80 percent prove to be benign, according to the National Cancer Institute in Bethesda, Maryland. "Breasts are usually uneven in texture, with small lumps that feel granular," says Eva Singletary, M.D., professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center in Houston. "Lumpiness is not a disease."

Experts recommend that you always bring any breast changes to your doctor's attention, particularly a lump that doesn't go away after a menstrual cycle or two. "Even if you find one like that, it's unlikely you have cancer," says D. David Dershaw, M.D., director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York City. Here's a quick guide to what a lump might really be:

If it feels like a small water balloon, it's probably a cyst. This fluid-filled sac, similar to a blister, most often forms in the ducts of the breast. Cysts typically occur in women over 30 and are harmless, but they can be painful. A breast surgeon can drain a cyst with a fine needle if it bothers you.

If it feels like a rubber ball, it's probably a fibroadenoma. This type of harmless growth can be the size of a pea or a lemon. It's usually smooth, firm or rubbery and moves when you push it. These lumps are most common in women in their twenties and thirties, but may appear at any age. Hormones from pregnancy or breast-feeding can prompt growths known as lactating adenomas. "It's usually best to remove fibroadenomas, not because they're dangerous, but because they may grow," says Dr. Dershaw. "It's easier to remove them when they're small, and the procedure is less likely to deform the breast."

If your breasts feel a little lumpy all over (like a bowl of chili), you probably have fibrocystic changes. At least half of all women have breasts that feel uneven in texture, sometimes with bumps like soft, cooked beans. Fibrocystic breasts often swell in response to your monthly hormones, and can be especially painful the week before your period. "These changes are harmless, but they can make breast exams difficult. It's harder to feel a dominant lump when breasts are lumpy overall," says Vicki Seltzer, M.D., vice president for Women's Health Services at North Shore-Long Island Jewish Health System in New York. Fibrocystic changes include any one of about 15 variations; only one type (atypical hyperplasia) may increase the risk of breast cancer if you have a family history of the disease. In most cases, the changes are harmless. And once you reach menopause, the problem usually disappears.

If it feels like a sponge, it could be a pseudolump. A pseudolump often doesn't have a distinct shape, and you can't feel any real edge; it's simply a dense or thick area in your breasts that has no known cause. True pseudolumps are benign, but because they are the most difficult kind of lump to diagnose, your doctor will often order more tests to rule out cancer, says Susan Love, M.D., a breast surgeon and chair of the Dr. Susan Love Research Foundation in Pacific Palisades, California.

If it feels like a piece of coral, it could be cancer. A lump that is hard, irregular and doesn't budge when you push it with your fingertips should set off an alarm. See your doctor as soon as possible.

Of course, no matter how it looks or feels, you should point out to your doctor any breast lump, bump, nipple discharge or skin changes such as scaliness or dimpling. She may recommend a diagnostic mammogram or ultrasound, which provide detailed pictures of just one area of your breast rather than scanning both breasts for possible problems. If those tests are clear, then it's safe not to worry. "But if a lump or symptom persists—even if a mammogram or ultrasound don't show cancer—consider asking for a biopsy anyway," says Dr. Dershaw.

And if a mammogram is not wholly clear, your doctor will probably perform a biopsy, during which she will insert a needle into the lump to remove tiny samples of breast tissue that can be checked for cancer cells. "It's a simple procedure that's incredibly accurate and hardly ever leaves the smallest scar," says Dr. Singletary. If your doctor doesn't order tests but you still feel concerned, get a second opinion, ideally from a doctor at a breast center. Most big cities now have breast centers, and they have the best track record for determining if anything is wrong—or if it's not, says William H. Hindle, M.D., founder of the Breast Diagnostic Center at the Women's and Children's Hospital in Los Angeles. Many insurance companies will cover a second opinion, but if yours refuses, it may be worth paying out of pocket, if you can, for a follow-up appointment.

Get the best breast exam

While experts hotly debate the value of performing monthly breast self-exams (see "Should you BSE?" right), one thing they agree on is that every woman should be examined once a year by her doctor. So make sure you get a clinical exam, and make sure it's thorough. In a very busy practice, your doctor may be tempted to skip the breast exam. In that case, "ask your doctor to do it," says Dr. Hindle; doing so may even make the doctor take more time and care performing it. At a minimum, "the exam should include all regions of the breast as well as your nipples, underarms and above the collarbone, and your doctor should look at you sitting up and lying down," Dr. Seltzer says. "I also like to examine breasts two other ways—with muscles tensed and relaxed." Do your part by scheduling your appointment after your period, when hormone levels are lower and breasts are less likely to be lumpy.

Worth noting: If you have a strong family history of breast cancer (several relatives diagnosed with the disease or a mother or sister who had breast cancer before age 50), you may need closer monitoring. One option for you: magnetic resonance imaging. A new Dutch study suggests that MRIs detect tumors in high-risk women better than mammograms do.

Now, lower your risk

Don't wait for a lump scare to get serious about lowering your breast cancer risk. Consider making these changes now:

Avoid fad diets. "Some women following trendy low-carb diets eat fewer fruits and vegetables than they should because they are so focused on eating protein. Some diets even forbid antioxidant- and fiber-rich fruits and vegetables like beets, sweet potatoes and oranges. That goes against everything we know about protecting yourself against breast cancer through diet," says Bridget Bennett, R.D., an oncology nutritionist at the Beth Israel Cancer Center in New York City. To reduce your risk of the disease, eat at least five servings a day of fruit and veggies. Not sure what that means? "Look at your plate. Is at least two thirds of it covered with vegetables, fruits, whole grains and beans? Is a third or less filled up with animal protein? If not, add more vegetables," says Melanie Polk, R.D., director of nutrition education at the American Institute for Cancer Research in Washington, D.C. And remember that whole grains are the healthiest carbs—a new study of women in Mexico found that those who had a diet high in starchy foods and sweets (think white bread and sugary sodas) were twice as likely to get breast cancer as those who ate a more balanced diet.

Get to a healthy weight. "There's more and more evidence that being overweight or obese is one of the strongest risk factors for breast cancer. Virtually all researchers are now convinced it's true," says Polk. What's healthy? Unless you were under- or overweight as a teen, you should limit weight gained as an adult to less than 11 pounds. Can't remember what the scale said back then? Check your body mass index. Keeping your BMI between 18.5 and 24.9 can reduce your risk 31 percent after menopause, when breast cancer risk climbs.

Exercise. Experts have known for years that physical activity cuts cancer risk, and new research just confirms the connection. In a study of more than 74,000 women, scientists at Fred Hutchinson Cancer Research Center in Seattle found that women who walked briskly or did other vigorous exercise one and a half to two and a half hours a week reduced their breast cancer risk by 18 percent.

Think before you drink. "We have stronger evidence than ever that heavy drinkers are more vulnerable to breast cancer," says Louise Brinton, chief of the National Cancer Institute's Hormonal and Reproductive Epidemiology Branch. An analysis of 53 studies worldwide found that in women who drink regularly, each daily glass of alcohol raises breast cancer risk 7 percent. But keep those statistics in perspective—if a woman under 40 has about a .01 percent chance of breast cancer, a drink a day ups that risk infinitesimally. Bottom line: Heavy drinking is not a good idea, but you probably only need to consider abstaining if you're at high risk for the disease.

Be comfortable with your breasts. Some women are still hesitant to feel their own breasts—a glamour.com poll of more than 3,000 women found that 22 percent never examine or casually touch their breasts. But regular contact is crucial; it may make you less afraid of breast cancer. "Sitting in that reception room waiting for my ultrasound was one of the most unpleasant hours of my life—there's so much fear in the room," says Herzig. "But now I feel more empowered. I am not shy with my body, and I'm constantly arranging, touching and tending to all my various parts. And there's no doubt in my mind that if anything like that ever comes up again, I wouldn't miss it."